Tildrakizumab and Abatacept: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 16, 2026 · Source data updated Jul 16, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Abatacept
Tildrakizumab
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Both of these medicines calm down parts of your immune system. Abatacept (Orencia) and tildrakizumab each turn down different immune signals to help control conditions like arthritis or psoriasis. When you take two immune-lowering biologics together, your body may have a harder time fighting off germs, so you could be more likely to get a serious infection, without getting extra benefit from the combination.
This concern is based on how these drugs work and on studies of similar combinations, so it is a precaution rather than something proven for this exact pair. The good news: your care team can manage this. Please talk with your doctor or pharmacist before using both, and watch for signs of infection like fever, chills, or a cough that will not go away.
Effect: Additive immunosuppression, increasing the risk of serious infection with no added therapeutic benefit.
- Mechanism: Unknown/pharmacodynamic. Abatacept (T-cell costimulation modulator) plus tildrakizumab (IL-23 p19 inhibitor) both suppress immune function; neither is a prodrug and no CYP/transporter pathway is involved.
- Direction/magnitude: Increased infection risk; magnitude not quantified. Extrapolated from abatacept + TNF antagonist trial data.
- Onset: Unspecified. Evidence: Theoretical.
- Management: Concurrent use of abatacept with other biologics for RA/PsA is not recommended. If transitioning between agents, monitor closely for signs of infection.
What happens
An increased risk of infection
Interaction Deep Dive
In controlled clinical trials, combining abatacept with tumor necrosis factor (TNF) antagonists led to a higher risk of serious infection while offering no extra therapeutic benefit. The data are inadequate to assess how safely and effectively abatacept can be given together with anakinra or with biologics indicated for rheumatoid arthritis or psoriatic arthritis. For this reason, using these agents at the same time is not advised. Patients being switched from TNF antagonist therapy to abatacept should be watched for signs of infection1.
Why it happens (mechanism)
Unknown
How to manage this interaction
The main step here is avoiding the combination. Guidance for abatacept says using it together with other rheumatoid or psoriatic arthritis biologics is not recommended, because the infection risk goes up without added benefit.
- Do not start or stop either drug on your own. Keep taking what is prescribed and bring this up with your prescriber or pharmacist.
- Your care team may choose one biologic rather than both, and may plan any switch carefully.
- If you are moving from one of these drugs to the other, your team may monitor you more closely for signs of infection.
- Report fever, chills, persistent cough, or any new infection promptly.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) Taking abatacept together with etanercept provided no extra efficacy but raised the risk of serious infection when compared with etanercept used alone. In a 1-year randomized study (N=121) that was followed by an open-label long-term extension (LTE; n=80), rheumatoid arthritis patients who were already receiving etanercept 25 mg twice/week continued that etanercept and were randomized to receive either abatacept 2 mg/kg IV on days 1, 15, and 30, and then every 4 weeks (n=85) or placebo (n=36). After the double-blind phase ended, patients could enter the LTE phase, at which point the abatacept dose was raised to approximately 10 mg/kg. At 6 months, the 2 mg/kg abatacept group demonstrated no significant improvement relative to placebo in modified American College of Rheumatology 20% (ACR20; 48.2% vs 30.6%) or ACR50 (25.9% vs 19.4%) response rates, though there was a significant difference in modified ACR70 rates (10.6% vs 0%). At 1 year, no significant differences in ACR20, 50, or 70 response rates were seen between the two groups. Serious adverse events occurred more often in the 2 mg/kg abatacept group (16.5%) at one year and in the 10 mg/kg abatacept group after 2 years of LTE (32.5%) compared with placebo (2.8%). At 1 year, serious infections were reported in 3.5% of the 2 mg/kg abatacept group and 0% of the placebo group 2.
b) In controlled clinical trials involving adults with active rheumatoid arthritis who received abatacept together with a tumor necrosis factor (TNF) antagonist (n=204) versus TNF antagonist therapy alone (n=134), the rate of infection (63% vs 43%, respectively) and of serious infection (4.4% vs 0.8%, respectively) was higher with the combined therapy; furthermore, the combined therapy offered no additional benefit 1.
Common questions
Can I take Tildrakizumab and Abatacept together?
Taking abatacept and tildrakizumab together is generally not recommended because combining two immune-lowering biologics can raise your risk of serious infection without extra benefit. Talk with your doctor or pharmacist before using both, and watch for signs of infection. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Tildrakizumab and Abatacept interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Tildrakizumab and Abatacept interaction managed?
The main step here is avoiding the combination. Guidance for abatacept says using it together with other rheumatoid or psoriatic arthritis biologics is not recommended, because the infection risk goes up without added benefit. Do not start or stop either drug on your own. Keep taking what is prescribed and bring this up with your prescriber or pharmacist. Your care team may choose one biologic rat… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Tildrakizumab or Abatacept need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (2)
- Product Information: ORENCIA(R) intravenous, subcutaneous injection, abatacept intravenous, subcutaneous injection. Bristol-Myers Squibb Company (per FDA), Princeton, NJ, 2020. DailyMed
- Weinblatt M, Schiff M, Goldman A, et al: Selective costimulation modulation using abatacept in patients with active rheumatoid arthritis while receiving etanercept: a randomised clinical trial. Ann Rheum Dis 2007; 66(2):228-234. PubMed
Keep reading about Abatacept
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